JENISE A CLARK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001680

License Status

NOT RENEWED

Business

First Name

JENISE

Middle

Last Name

CLARK

Business Name

JENISE A CLARK

Original Issue Date

11/06/2001

Effective Date

03/04/2014

Expiration Date

03/01/2016

City

PEORIA

State

Zip

85383

County

ARIZONA

Ever Disciplined

LastModifiedDate

04/25/2016